Low Back

The #1 Reason Your Back and Hip Pain Has Not Resolved

People deal with low back and hip issues on a weekly and monthly basis. Unfortunately in some cases, low back and hip discomfort can be a daily struggle. 

Seemingly simple tasks such as bending forward to put your socks and shoes on, or transitioning in and out of your car become more difficult. In some cases, it's annoyingly uncomfortable. 

A lot of people will try various different stretches, strengthening, and stability based exercises to help improve their symptoms. They may even had tried massages or various different manual therapy techniques. These are all great ideas, and work well in a lot of cases. However, there is another subset of people who do not respond to typical measures of exercise and rehab. It is also very possible that if your noticing progress, but it just seems to be slow. There could be other factors you have not yet considered which has slowed or plateaued your progress.

In the video below, I'm going to be discussing one of these reasons.

It's not often NOT talked about by your rehab clinicians or personal trainers. It certainly is never discussed in the 15 minutes you get to spend with your primary care physician or orthopedic consult. And yet, it's one of the most basic things that all humans must be able to every day. 

If your still looking for answers and reasons for why your back or hip pain may be lingering around longer than you'd like, we at On Track Physiotherapy can provide answers and give you the time necessary for an explanation.

The first step is setting up a discovery visit so you know what to expect. We can answer any questions ahead of time, and if you feel that we are a good fit then we can move forward with treatment. Let us know the outcome you'd like to achieve, and we can tell you how our services can better help get you to that point. 

Low Back Specialist Physiotherapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Low Back Compression Explanation

Do you frequently wake up in the morning with a "tight" back?

Does your body just feel stiff and doesn't want to loosen up?

In this video we explain why people start to experience stiffness or tightness in their back that just doesn't want to ease up. 

The good news, is there are effective strategies to put a halt to this once and for all! Set up FREE discovery visit with On Track Physiotherapy to learn how.

3 Reasons Why Your Still Feeling Low Back Pain, Stiffness, and Tightness

Chronic low back pain, stiffness, and tightness is one of the most common things I see and treat in the clinic on a daily basis. 

If you are currently experiencing low back pain, stiffness, or tightness that just doesn't seem to go away. You are not alone. In fact, millions of people deal with this issue unfortunately on a daily basis in the United States.

Many misconceptions about low back pain exist from individuals giving generalized recommendations. In today's article, I will discuss 3 common reasons why you're still experiencing pain, stiffness or tightness in the low back that not many people talk about.

If you have ever been to the Doctor and been given diagnosis such as: degenerative disc disease, spinal stenosis, etc. you'll want to be sure to read all the way through. Too many healthcare clinicians give out diagnosis but don't ever explain what's going on and why your experiencing the current issues in the first place. If your going to try to solve a problem, wouldn't it make sense to first understand what the problem is?......

Reason #1 ) Your body craves stability and control. If you are unable to provide it with enough control actively (using your muscles) then it will find a way to do it passively (bones, joints, ligaments, etc). Muscles have a much greater capacity to recover than passive structures, especially in the long term. 

Reason #2) Does it feel like you are constantly arching your back? Take a look at the picture above. See how the hips shift forward, the beltline points downward, and the ribs point upward. This is a position of extension and compression. Which in and of itself is not a bad thing. We just don't want to live there 24/7. 

Anyways, you will find people who frequently stand, sit, walk, etc. in this position. As you can see from the lines drawn, this puts a lot of compression on the low back structures and creates a lot of tightness in those low back muscles. Said another way, if you are in that position frequently, you are relying on passive structures to support your body frequently.

Reason #3) Let's look at this position a little more.... Below is a picture of a pelvis and low back model with the joints in "neutral". Neutral is a relative term, because when you move so does your joints. 

However if you are relying on passive support systems and compression to create control then your body defaults to that positional strategy. Which is the picture below. Notice how the hips flare further out to the side and the back hip bones start to approximate toward midline reducing space.

Hopefully these pictures provide some clarity for you. Holding a pelvis model in one hand and taking a picture in the other is not an easy task, but I think you get the point....

Frequent extension, compression, and passive support lead to feeling achy, sore, stiff, and tight. On Track Physiotherapy is your solution to finding an active way to provide relief and stop the daily annoying nuisance your back is currently experiencing. 

Not yet ready to come in for a visit, no worries. But please get started doing something....Click below to get your free report on Low Back and Hip Pain. 

Low Back Specialist Physiotherapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Sciatica, Back Pain, and Associated Leg Pain

Sciatica, back pain, and associated leg pain can be really annoying to deal with. It can make simple tasks like sitting, sleeping, or walking a nightmare. Fortunately, we’ve had a lot of great success with these folks so thought I’d share a couple examples.

Often these issues can be difficult to treat (especially if you have been dealing with them for an extended period of time) but we like a challenge!  Always being mindful of how the location of the pain extending down your leg can be a dead give away as far as what area to target in treatment.

There are other ways to narrow down the location of the problem as well:

  • The muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • Reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve L4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So below are a couple great examples of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • Minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • Moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • Springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with IASTM to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and IASTM.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

If this sounds similar to you or would like some assistance in your recovery, then click the link below to receive a FREE discovery session.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi.

Follow On Track PT and Performance on Facebook.

5 Secrets for Decreasing Low Back Pain… Without Medication or Visiting the Doctor

Secret #1 – Don’t Focus Just on the Back

Low back pain is a very common problem, and is a topic that comes up often when people find out that I am a physical therapist. The problem with low back pain is that there are a number of different factors that could be contributing to the issue. Without a thorough evaluation, it is impossible to give a direct recommendation. Please don’t think that I am trying to weasel out of the question, but low back pain is probably the most complex area to treat and generalized recommendations get generalized results. With that being said, the purpose of this document is to give you useful information and take home points that can help give you some relief today! If you understand the functions of the segments above and below the low back, a solid correction program can be initiated.

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The picture above provides a simple summary of the movement capabilities in different areas of the body. Front and center is the low back, which as you can see, the main function in this area is stability. Above and below the low back are your hips and thoracic (mid) spine. Both of these segments require a great deal of mobility. If you think about this for a minute, it makes perfect sense. The joints with the greatest natural range of motion and degrees of freedom are intended to be mobile, and those with limited ranges are intended to be stable. If areas that are supposed to be mobile do not function optimally, then the body is going to have to create the mobility somewhere else. Most of the time this happens at the expense of areas that are intended to be predominantly stable (in this case the back).

Secret #2 – Start Moving

One of the biggest mistakes some people make after getting back pain is they stop moving completely because they are afraid of making it worse. The problem with this is that if you want to get out of pain, you’re going to have to start moving at some point. Doing absolutely nothing will do absolutely nothing to give you relief. It may sound obvious, but find different movements and positions that don’t cause as much pain then repeatedly get into those positions and movements until things start to ease up a bit. When your back or hip pain is affecting the way you walk, sit, get out of a chair or drive, its definitely time to do something so this doesn’t last longer than it needs to for recovery. Below is a very simple example that often times many people can start doing early on in their recovery process.

Secret #3 – The Easiest Way to Start Moving

I realize point #2 and #3 are the same thing. This was done on purpose, because I like action takers and people who are proactive about getting better. Now as prefaced in this guide, back pain can manifest itself in a variety of ways and a variety of intensities. So if your back pain is severe, be sure to start this exercise out slowly in a small range of motion and move on from there. If you feel your pain is worsening, please use common sense and stop (it should go without saying, that this exercise may not be for everyone). With all that being said, here is one of the easiest exercises I have found to start easing back pain and get someone moving again after treating hundreds of people over the years with back pain.

Secret #4 – Ease Back Pain by Reducing Compression on the Back

You are probably asking “how can I do this?” Or “how do I know if this is a problem?”

The simplest way of telling if you are naturally too extended or compressed in the back more so than normal is to lay flat on your back and look at your ribcage. If you identify a large rib flare on one or both sides, this could be playing a role in your back and hip symptoms. Below is a picture of what I am talking about.

Here is a simple exercise that you can do to help combat this issue and relieve some compression at the back. Note: this exercise is only scratching the surface on how we can address this issue.

Secret #5 – Movement Assessment

Having a trained eye watch how you move through different ranges of motion and see where limitations might exist in hips, spine, among others. This will often direct which set of particular exercises and potentially manual therapy techniques would be most important for your particular set of limitations. Sometimes generalized exercise and soft tissue work will not do the trick. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks. This allows us to help you get off painkillers, get some sleep, and continue to move as fast as possible. If that sounds like something you’d enjoy, then let us know by filling out this quick questionnaire below and inquire about a FREE Discovery Visit.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Adductor Pullback

The adductor pullback is a exercise designed by the postural restoration institute (PRI). The exercise is designed to get the client to shift into their left hip mimicking the qualities of left stance. Left stance is important due to the body's natural asymmetry that is present which creates a predictable set of compensation patterns. Often times you will find individuals with low back or hip pain who demonstrate lack of hip internal rotation on the left leg as opposed to the right leg. This exercise is one of the potential steps one could take to improve hip internal rotation specific to the left leg. 

Core Stabalization Progression

The Wall Press Abs exercise is an excellent way to learn how to create protective stiffness in the spine. When performed correctly it will help create stability through your low back and aid in creating increased mobility through your hips. Being able to dissociate between the low back and hips/pelvis is a region where many people with hip or back pain struggle. 

By pressing your arms into the wall you will help engage your abs. Holding this position, then taking a breath in then exhaling and allowing your ribs to drop down will activate you oblique muscles further. Then maintaining this position of ribs down inhaling and exhaling will incorporate your diaphragm which is a muscle and spinal stabilizer as well.

Finally you will begin to move or extend your legs out which will continue to challenge core control while you work hip mobility. Below are the progressions from easiest to most advanced.

Low Back Pain - Ann Arbor, Mi

Ann Arbor Physical Therapy Low back pain is one of the most common ailments in the United States. A number of contributing factors can play a role in this type of dysfunction. One of the most common reasons that your back may hurt is due to your hips. More specifically the lack of range of motion in your hips. In a study published by the Institutional Journal of Sports Medicine titled Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. The authors found that typical range of motion in the hip lacked -4 degrees of extension from a neutral position. In those subjects without low back pain, they had 6 degrees of hip extension available beyond neutral. All totaled, this is a 10 degree difference in hip ROM. These findings are common in individuals for a number of reasons. One in particular is the tendency for people to sit for long periods at work, school, or home which puts your hips in a flexed position (opposite of extended). This is a video of one technique we use at On Track PT and Performance to help improve hip extension through neurological inhibition.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.